Provider Demographics
NPI:1316539026
Name:SUNDE M NESBIT PHD
Entity Type:Organization
Organization Name:SUNDE M NESBIT PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SUNDE
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:NESBIT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:765-532-7955
Mailing Address - Street 1:408 DOUGLAS AVE STE C
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6260
Mailing Address - Country:US
Mailing Address - Phone:515-232-2567
Mailing Address - Fax:
Practice Address - Street 1:408 DOUGLAS AVE STE C
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6260
Practice Address - Country:US
Practice Address - Phone:515-232-2567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA600675432Medicaid